Lessons learned as a new grad nurse.

When I graduated nursing school in 1997 at the ripe old age of 21, I felt like the career world was going to welcome me with open arms.  I was one of the few “traditional students” who came right out of high school into a Bachelor of Science in Nursing program and had been told through those 4 years about the nursing shortage that existed.  Finding a job was going to be very easy, especially for a prepared nurse with a BSN, I was told.  So I passed my NCLEX, bought a fancy new interview suit (minus the ruby red slippers...thought that might be over the top), made a ton of copies of my resume and headed out to seek the “Wizard”, only to have the gate closed in my face time and time again.  However, I was in the top of my class, smart, President of the local chapter of Nursing School Association, a real go-getter, and I was going to “follow the yellow brick road”, until I got to “the Emerald City”!

Me (new grad): “I would like to see the Wizard Please (aka Hiring Manager) Gatekeeper (HR Dept): “The Wizard?!! But no new grad can ever see the Wizard!!”

Keep in mind that technology has not always been what it is today.  Some of us over 40-somethings had word processors or basic computers to type resumes on, and social media did not exist for job searches.  You had to put on those ruby red slippers and hit the yellow brick road to find a job.  Newspapers and nursing magazines posted job listings, but other than that, you went door to door with resume in hand.  I can not begin to tell you how many Human Resource centers I visited that summer of 1997 looking for a job.  I went to every hospital in an 80+ mile radius, then moved into wound care centers, homecare, nursing homes, and doctors office after doctors office.  To be honest I did not want nearly all of the jobs I applied for, but as my instructors said “one must practice interview skills” and “you never know what might open the door to another opportunity”.

I truly felt like Dorothy from the Wizard of Oz. I had spent so many years and countless hours studying to be a prepared nurse with a BSN. I had my stuff together and I was so eager to work, but I could not get past the gatekeeper in the Emerald City.  I was told over and over again, “We don’t hire new grads”.  I felt like, if I could just get in to meet the Wizard then I could speak for myself and they would surely see I was a serious and worthwhile candidate to consider. Alas, ”No new grad sees the Wizard”.

Finally, I got a chance at a local Hospice center.  They had an open environment office, so when I went in to leave my resume, the nurse manager heard me and came up to greet me.  She interviewed me a few days later with the entire hospice team and gave me a chance!  I worked there for 5 years eventually becoming the Nurse manager myself before moving on.  “All in due time dear…” That job molded me into the caring and compassionate, critical, and quick thinker that I am today, and for that I am forever grateful! Take EVERY interview you can. Apply EVERYWHERE. We all have to start somewhere and these experiences help us gain knowledge, humility, respect, and skills, skills, skills!

“You’ve always had the power my dear; you just had to learn it for yourself”

Another painful lesson I learned in my beginning days of “big girl nursing” (on my own, no hand holding) is to trust my gut instincts.  No matter how fresh you are out of nursing school, we all as have that inner voice that tells us when something is just not right.  This plays out easily when fellow staff and physicians agree with you, but there are times when you will have to stand strong on your own.  One of the biggest and perhaps the most valuable piece of advice that I can pass on, is to do your homework first before sending out your flying monkeys!

For example, what will you do when you have a patient that just doesn’t seem quite right?  Say you have taken care of this patient 2 days in a row and something is just off today.  Do not immediately rush to panic and call the doctor, (unless of course it is an immediate life or death situation).  Do some critical thinking.  Assess the patient from head to toe and check against the prior few days assessments noting differences.  Check lab values for changes, know (and LOOK at) what fluids and bags your patients IV pole has hanging on it.  Double check written orders and consult notes and when possible speak to the patient and ask specific questions.  When all this info is gathered call the physician.  Wait by the phone for the return call, (not doing so is the biggest frustration for doctors who are short on time, trust me, I am married to one).  Then provide a concise statement with concerns and supporting evidence.  If the doctor does not feel your issue is of concern, but you still have a bad feeling, call your unit supervisor to look at the patient and go on from there.  Many of my patient’s lives have been saved because of the gut instinct.  Trust yourself and fine tune your skills along the way!

“Courage doesn’t always roar. Sometimes courage is that quiet voice at the end of the day saying, ‘I will try again tomorrow’”.

Courage is a quality that you learn and build on throughout your entire nursing career.  From the first job interview you go on, to the first time you code YOUR patient that looked fine 5 seconds ago, to the first belligerent doctor ,medication error, a nurse bully, or angry family member, etc. The list goes on and on.  I can’t say any of that gets any easier, but I can say that you become more seasoned with each experience!  You see what worked and what didn't, you learn how to stand up for yourself, what is right, and most importantly your patients. As the quote says, that roar is not always loud, but it's in there.

Nursing is not about knowing everything from day one.  Most everything you need to know, you do not learn in nursing school.  I learned very quickly to find a great mentor, strong knowledgeable nurses around me, and to learn where to go when I don’t know something.  I can’t tell you how many times I told patients or families, “ya know what, I am not sure about that.  Before I give you an answer let me look into it further”.  Ask colleagues, use references, ask doctors and residents, pharmacists, whoever might be knowledgeable.  In nursing there really are no stupid questions.  Stupid is not asking and potentially causing harm to yourself, patients, or families.

There will be really great days, when you leave work feeling like Glenda the good witch, all fluffy and calm, satisfied that your patients did well, you helped people out, helped a patient die peacefully, educated patients, got your meds passed out and charting done on time.  However, there are many days that you feel like a tornado has dropped a house on you and someone is trying to steal your pretty shoes.  Courage is realizing that we are not always in control.  Your shift ends, another nurse relieves you.  You can go home, relax, go to sleep and start fresh the next day with a clean uniform and courage on your sleeve.

So Dorothy, your school of nursing has landed you in Oz.  You’re not in Kansas anymore.  Confidently slip into those ruby red slippers, grab your basket of tools and resumes, tuck Toto under your arm and head down the yellow brick road.  You will meet so many wonderful, and some not so wonderful people along your journey that will mold you into a confident nurse if you’re committed to listening and learning from them. You will find a great support team who has heart, courage and the wisdom to get you to the Emerald City.  Remember what you go through and hold it close to your heart so that you can help others along their yellow brick road!



About the Author

My name is Sarah Matacale RN, BSN, CCS.  I have been a nurse for 20 years and have practiced in a variety of care settings.  My passions have always been with Hospice care and Cardiac Critical Care, however due to unknown reasons, I lost a large percentage of my hearing bilaterally about 4 years ago with a continuous decline over the years.  This meant I had to find new passions and a way to reach out in the healthcare environment.  I went back to school to obtain a certification in Medical Coding and Billing and passed the national certification exam.  I was also presented with the opportunity to start healthcare freelance writing. I am employed by Vidant Medical Center as a Certified Documentation Improvement Specialist.  This has become my new way to reach patients, caregivers, and fellow healthcare workers in a fun and fulfilling way!